Do dual eligible beneficiaries experience better health care in special needs plans?

Health Serv Res. 2021 Jun;56(3):517-527. doi: 10.1111/1475-6773.13620. Epub 2021 Jan 13.

Abstract

Objective: Dual Eligible Special Needs Plans (D-SNPs) were intended to provide better care for beneficiaries eligible for both Medicare and Medicaid through better coordination of these two programs.

Data sources: 671 913 dual eligible (DE) respondents to the 2009-2019 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

Study design: We compared the 2015-2019 experiences of DE beneficiaries in D-SNPs relative to fee-for-service Medicare (FFS) and non-SNP Medicare Advantage (MA) using propensity-score weighted linear regression. Comparisons were made to 2009-2014. 12 patient experience measures were considered.

Data collection methods: Annual mail survey with telephone follow-up of non-respondents.

Principal findings: More than 65% of DE beneficiaries enrolled in FFS. Of 12 measures, D-SNP performance was higher than non-SNP MA on two (P < .05), lower than non-SNP MA on two (P < .05), and higher than FFS on four (P < .01). DE beneficiaries did not report better coordination of care in D-SNPs. D-SNP performance was often worse than other coverage types in prior periods.

Conclusions: Relative to FFS Medicare, DE beneficiaries report higher immunization rates in D-SNPs, but slight or no better performance on other dimensions of patient experience. New requirements in 2021 may help D-SNPs attain their goal of better care coordination.

Keywords: Medicaid; Medicare; patient experience; special needs plans.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Continuity of Patient Care / organization & administration
  • Fee-for-Service Plans / statistics & numerical data*
  • Female
  • Health Status
  • Humans
  • Male
  • Medicaid / statistics & numerical data*
  • Medicare / statistics & numerical data*
  • Medicare Part C / statistics & numerical data*
  • Mental Health
  • Middle Aged
  • Patient Satisfaction / statistics & numerical data*
  • Propensity Score
  • Quality Indicators, Health Care
  • Quality of Health Care / organization & administration
  • Socioeconomic Factors
  • United States
  • Young Adult